Tongue-in-Groove Setback of the Medial Crura to Control Nasal Tip Deprojection in Open Rhinoplasty

Overprojection of the nasal tip is a common problem in aesthetic Caucasian and Mediterranean rhinoplasty patients. In these patients, shortening of the conjoined medial crura frequently plays an important part in deprojection of the nasal tip. The combination of vertical incision maneuvers of the medial crura and tongue-in-groove (TIG) allows the surgeon to achieve significant control over projection, rotation and shape of the nasal tip. In this article we present our graduated approach towards nasal tip deprojection in aesthetic Caucasian and Mediterranean rhinoplasty together with a statistical analysis of overall success. This retrospective study based on 22 consecutive Caucasian or Mediterranean patients who had aesthetic, open deprojection rhinoplasty combining TIG with either footplate resection or medial crural overlay by one surgeon between 2009 and 2011. Aesthetical success was determined by statistical analysis of change in subjective body image in relation to nasal appearance, scored on five aesthetic 5-point Likert Scale questions and a 10 cm visual analog scale. Change in projection was calculated using a modified Goode method, applied on standardized pre- and postoperative photographs which were also used to measure change in rotation. Subjective body image in relation to nasal appearance improved from 15.14 to 6.55 (p < 0.01). The mean aesthetic VAS score improved from 3.32 to 7.91 (p < 0.01). Substantial deprojection was measured in 19 patients (86.4 %) with a mean deprojection ratio of 0.06 [range 0.02-0.16]. An increased projection ratio of 0.03 was encountered in one patient and in two patients projection was unchanged. Analysis of objective and subjective aesthetic outcome data suggest that our deprojection algorithm helps to deliver consistently good results in Caucasian and Mediterranean patients who require open deprojection rhinoplasty. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.